Attach_010_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

(To be completed by the Offeror) Contractor:____________________ Contract No.:____________________________ Subcontract No. (if applicable):_________________________________ POC:________________________ Title:________________________ (Name) (E.G. PCO/ACO/TM) (Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

Attachment 010

(To be completed by Respondent Point of Contact)

PART II. IDENTIFICATION OF SECURITY SERVICES PROVIDED UNDER

CONTRACT (Check all those that apply)

Armed Security Guards, Stationary and Roaming.

Comments:

Visitor Control, Compliance with Visitor Protocol.

Security Screening at Entry Control Points.

Security Escorts

Security Escorts with TS/SCI Clearances

Security Administration, including visitor databases and advance clearances.

(To be completed by Respondent Point of Contact)

PART III. CONTRACT PERFORMANCE EVALUATION

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

Acceptable Unacceptable (Explanation must be provided in Comments field below)

B. Effectiveness of Project Management .

C. Timeliness of Performance for Services and Product Deliverables.

D. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

E. General Comments. Provide any other relevant performance information.